Choosing Words Carefully in Eating Disorder Treatment

As a research assistant at the Center for Eating Disorders at New York-Presbyterian Hospital’s Weill-Cornell (Westchester) campus, I have the opportunity to regularly observe interactions between patients and clinicians, as well as discussions that occur among the clinical team at daily rounds. Among the most striking patterns that I’ve noticed is how often possessive adjectives are used when eating disorders are assessed or described.

“When did your eating disorder begin?” a clinician might ask a patient at intake to the program.

“Well, my disorder started…,” he or she replies.

Later, the clinician presents the case to the treatment team saying, “Her disorder has an atypical presentation…”

This subtle and perhaps unconscious choice of language concerns me, because to me it conveys one has ownership over a devastating illness and conflicts with an essential treatment goal: to help patients separate themselves – who they are – from the disorder. One of the greatest challenges in eating disorder treatment is the degree to which the afflicted individual experiences symptoms of the disorder as a fundamental part or representation of their personality and values. The psychological term for this feature is ‘ego-syntonic.’

Consider, for example, the young woman struggling with anorexia nervosa who says, “being a careful eater and regular exerciser is just part of who I am.” Or, the man with bulimia nervosa who maintains that he has “never been a person who eats dessert.” Viewing behavior as longstanding preferences in line with personality perpetuates a notion about what is and is not “normal” or “healthy,” and can contribute to trouble accepting the concerning consequences of health-related behaviors.

The use of possessive adjectives about an eating disorder during treatment underscores the assumption that features of an illness are actually features of a persona. Clinicians and patients must work together to change the dialect in the field, and to challenge stigma about what it means to have a mental illness.

Consider cancer; patients with this illness would almost never view it as ego-syntonic. They have little interest in taking ownership of cancer or accepting it as a piece of their identity, viewing it more as a terrible misfortune that should be immediately mitigated. Clinicians, patients, or families affected by cancer might say, “He beat the cancer” or “The cancer has come back.” There is implicit agreement that the condition is dystonic, or distinct, from whomever it afflicts.

To convey a similar degree of separation between patient and illness, those with eating disorders and the clinicians treating them might modify the way they talk about the eating problem with a few simple steps:

  • Instead of asking when “your” eating disorder started, providers can inquire about when “the” symptoms began, and assure the patient that they will treat “this” problem together.
  • Clinicians can encourage patients to make the same linguistic change by redirecting them away from possessives like “my” and “mine” when describing their illness, in favor of articles like “this”, “that” and “it.”
  • In a group format, patients might point out this ‘possessive pronoun tendency’ to one another, and help one another shift the language a bit.
  • An individual with an eating disorder can try looking to their community for alternative models of how people relate to illnesses. This might involve identifying a friend or relative who has conceptualized and referred to another type of mental or physical condition as clearly separate from themselves.

Our brains are highly sensitive to subtle cues, and eliminating possessive terminology from eating disorder treatment is a simple linguistic change with potential to make a difference on a complicated aspect of these illnesses. This could affirm to patients that these illnesses need not be forever – that recovery is possible. It could foster a stronger bond and understanding between patient and provider about the problem, and allow for a partnership in which patient and clinician work together to fight the disorder. Finally, severing the link between oneself and one’s diagnosis may help a person to challenge eating disorder thoughts more easily, and to more effectively make necessary behavioral changes.

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  1. I always appreciate sensitivity to person-centered, recovery-oriented language and love this article!

    I have thought about these pronouns before and actually see it differently. To me, referring to the eating disorder as “mine” rather than “it” actually creates more distance. If something is “mine,” I am not “it.” For example, my thoughts are mind, but I am not my thoughts. My emotions are mine, but I am not my emotions. My headache is mine, but I am not my headache. With some clients, I am concerned that “it” can create a sense of powerlessness and can diminish the presence of the healthy self.

    I love geeking out over conversations like this. Thanks for the article!

  2. I’m not sure what the answer is but I don’t view ‘my’ eating disorder as an illness either, so symptom based language wouldn’t work for me. I think it is a particular way of being I have become caught up in, and I am trying to untangle myself from this and design a different way of coping with my life, viewing myself etc. Thinking about it, I do always say ‘my eating disorder’. I rarely use the word ‘anorexia’ even though that is my diagnosis. Interesting one. I’d say we need a more radical shift from either alternative offered here, to something entirely different. Interesting thoughts though.

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